CUSTOMIZED CROSS-LINKING COMBINED WITH SURGICAL ABLATION VERSUS INTRASTROMAL RING FOR MODERATE KERATOCONUS

Abstract

Introduction: Keratoconus is characterized as a progressive corneal ectasia marked by corneal thinning and deformation, resulting in optical irregularity, increased astigmatism, and reduced visual acuity. In moderate cases, conservative and surgical therapeutic strategies aim to halt disease progression and improve visual quality; notable approaches include personalized corneal cross-linking combined with surgical ablation and intracorneal ring implantation. Personalized cross-linking allows for greater treatment individualization by considering the cornea's topographic and biomechanical characteristics, while topography-guided ablation promotes better regularization of the corneal surface. Conversely, intrastromal rings facilitate structural corneal remodeling, reducing protrusion and improving contact lens fitting, making them a relevant alternative for patients with moderate keratoconus. Methodology: This review was conducted following the PRISMA checklist, utilizing scientific articles published over the last 10 years in the PubMed, SciELO, and Web of Science databases. The following descriptors were used: “keratoconus,” “corneal cross-linking,” “intracorneal ring segments,” “topography-guided ablation,” and “corneal ectasia.” Clinical studies, scientific reviews, and research involving patients with moderate keratoconus undergoing the evaluated techniques were included. Duplicate studies, publications without full-text access, and research addressing other corneal diseases were excluded. Results: The analyzed studies demonstrated that personalized cross-linking combined with ablation provided greater corneal surface regularization, improved topographic indices, and functional visual gains, particularly when indicated for corneas with documented progression. Intrastromal rings showed benefits regarding the reduction of corneal curvature, improved symmetry, and anatomical stabilization, proving especially useful for patients with significant structural irregularity. Evidence indicated that both techniques were clinically safe, though they involved distinct mechanisms of action and outcomes dependent on appropriate patient selection. Conclusion: It was concluded that personalized cross-linking combined with surgical ablation and intrastromal rings represented effective alternatives for treating moderate keratoconus. The choice of therapy depended on individual corneal characteristics; the personalized approach demonstrated greater potential for visual optimization, whereas the rings stood out for their capacity for biomechanical remodeling and ectasia stabilization.